Examining primary care physician rationale for not following geriatric choosing wisely recommendations

BMC Family Practice

Theresa A. Rowe¹  Jeffrey A. Linder¹  Tiffany Brown¹  Stephen D. Persell²  Jason N. Doctor³ 

[1] Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N Lakeshore Dr. 10th Floor, 60611, Chicago, IL, USA;Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N Lakeshore Dr. 10th Floor, 60611, Chicago, IL, USA;Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA;Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA;

关键词: Choosing Wisely;    Overuse;    Older adults;   

DOI  :  10.1186/s12875-021-01440-w

来源: Springer

【 摘 要 】

BackgroundThe objective is to understand why physicians order tests or treatments in older adults contrary to published recommendations.MethodsParticipants: Physicians above the median for ≥ 1 measures of overuse representing 3 Choosing Wisely topics. Measurements: Participants evaluated decisions in a semi-structured interview regarding: 1) Screening men aged ≥ 76 with prostate specific antigen 2) Ordering urine studies in women ≥ 65 without symptoms 3) Overtreating adults aged ≥ 75 with insulin or oral hypoglycemic medications. Two investigators independently coded transcripts using qualitative analysis.ResultsNineteen interviews were conducted across the three topics resulting in four themes. First, physicians were aware and knowledgeable of guidelines. Second, perceived patient preference towards overuse influenced physician action even when physicians felt strongly that testing was not indicated. Third, physicians overestimated benefits of a test and underemphasized potential harms. Fourth, physicians were resistant to change when patients appeared to be doing well.ConclusionsThough physicians expressed awareness to avoid overuse, deference to patient preferences and the tendency to distort the chance of benefit over harm influenced decisions to order testing. Approaches for decreasing unnecessary testing must account for perceived patient preferences, make the potential harms of overtesting salient, and address clinical inertia among patients who appear to be doing well.

【 授权许可】

CC BY